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Friday, June 14, 2013

Dengue - of platelets and papaya leaf juice

My wife was recently diagnosed with dengue fever.

Medical literature says that you must suspect dengue if you have fever accompanied any two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pain, nausea, vomiting, swollen glands or rash. But she didn't have any of them; only fever.

Her illness gave me an opportunity to learn about the disease. Here are some points. I have sourced the following from doctors and web pages of recognized health institutions.

(A diary of my wife's case is below the FAQs)

What is dengue?
It is a viral infection caused by the bite of a mosquito (female Aedes aegypti mosquito), which has previously bitten a dengue patient. The disease is transmitted this way: patient-mosquito-healthy person. The symptoms surface 3 to 14 days after the bite.

When should I suspect it could be dengue?
If you have fever that doesn't go with paracetamol tablets within 2 days, go to a doctor. You may or may not have other symptoms like headache, pain behind the eyes, muscle and joint pain, nausea, vomiting or rashes.

Is low blood platelet count, a sign of dengue?
As a first test, doctors order a blood test. The result would give lot of clues on why you have fever. A drop in platelet count could be a sign of dengue. The normal range is between 1.5 lakh and 4 lakh. But a drop in platelet count is no confirmation of dengue, as the count drops with any infection. So, a specific test for dengue is ordered.

After dengue is confirmed, with the specific test, the disease is monitored by looking at the count of the platelets. Typically, in a dengue patient, the platelet count keeps dropping. How fast and how much depends on many factors like immunity of the person and the severity of the attack.

Blood platelets help the blood to clot. When the count drops, there's a risk of bleeding. So patients are advised even not to brush teeth, because the gums could bleed. There are also dangers of internal bleeding.

The platelet count is monitored every 24 hours. But once the count goes below 50,000, every 12 hours the count is checked. Doctors won't let the count drop. Once it reaches a threshold level -- around 15,000 to 20,000, or even 25,000 -- platelets are injected.

Once the infection is out of the body, the platelet count starts increasing: at first slowly and then rapidly. The rate depends on the general health of the patient.

Is dengue dangerous, fatal?
If detected and treated early it is not. There is no need for panic or fear. A severe form of dengue can be dangerous, and even fatal without early medical intervention. So don't ignore the flu-like symptoms. Visit a doctor.

What is the cure for dengue?
There are no medicines for dengue. Doctors give medicines for the symptoms; and intravenously administer fluids. Patients are told to have plenty of fluids, like water and fruit juice; and have normal food. Nausea and vomiting reduces food intake; and that, combined with the infection, makes the patient weak. The infection lasts about a week. Even after fever is gone, the patient takes about one or two weeks to recover from the tiredness. Fluids, and more fluids, is the only way out.

How beneficial are papaya leaves?
Word has gone around that pomegranate and papaya; and the juice taken out of crushed
pomegranate skin, papaya and neem leaves are said to be good for
generation of platelets. Doctors merely advise patients to have any fruit. Though benefits of pomegranate and papaya have been well known, the benefits of papaya leaf juice is a new development.

People who have taken papaya leaf juice have spoken of dramatic rise in blood platelet count: for example, from 30,000 to 2 lakh; and from 80,000 to 3.5 lakh, within 24 hours. In Kerala, I am told that not just ayurvedic doctors, but allopathic doctors too, are advising patients to have the papaya leaf juice. I was advised by a couple of nurses to give the juice to my wife. I am also told that tender papaya leaves are being sold at a premium in Kerala.

In the hospital where my wife was being treated, a patient was being given papaya leaf juice right from day one. But that didn't help much, it looks like, since her platelet count went down to 15,000 and she had to
be administered platelets twice. But after she was cured of the infection, the
count went up dramatically fast: from 55,000 to 1,30,000.

There is no well-validated and documented scientific backing for this. It's merely an anecdotal evidence. Allopathic doctors are not very forthcoming in giving any credence to this. Ayurvedic doctors say there is an urgent need to research thoroughly the correlation.

Doctors say once the virus is out of the body and the infection is over, the platelet count will naturally increase with normal food. But most patients tend to have lot of pomegranate and papaya, as part of the diet; and some go a step further and include the juice from crushed papaya leaves. So whether the rise in platelet count is a natural phenomenon or aided by fruit and juice is not clear.

One way of looking at it is: any way the platelet counts will increase once the infections is gone; and the other way of looking at it is: the fruit and juice have played a role. Until a proper scientific investigation is carried out, we wouldn't know for sure the effect.

The effect of any medicine depends a lot on the individual's health. The effect of such remedies vary a lot from individual to individual.

(November 30, 2015 Update: My uncle has been admitted to Chaya Hospital, with viral infection and fever. Though dengue was ruled out, his platelet count is down to 65,000 because of the infection. Doctors have prescribed Caripill, which is made of papaya leaf extracts, in order to boost the platelet count. This means allopathic doctors are recommending this ayurvedic solution.)

How to prevent dengue?
Tough. since it's very easy for a mosquito to bite you, and it's very difficult to keep that one mosquito away. But the following steps could be helpful.

Don't allow yourself to be bitten by mosquitoes.

Regularly spray mosquito repellents.

If you are in a mosquito-prone area, apply some mosquito repellent on your skin.

If there are too many mosquitoes, cover your body; and while sleeping use mosquito net, since the effect of the repellent may not last too long.

Wednesday, June 5
She got fever on Wednesday (June 5) morning. She had Crosin. The fever didn't go.

Saturday, June 8
After 72 hours, we went to Manipal Hospital at 9 am on Saturday. She was asked to take a blood and urine test. When we got the results at 12.30 pm, we found that all her parameters were normal, except the blood platelet count. It was 1,20,000. It should be at least 1,50,000. She was advised to get admitted to hospital. A specific test for dengue was also ordered.

Manipal Hospital has been seeing a rush of dengue cases. A lot of patients were also being referred to the hospital by smaller hospitals and clinics. There was no bed available and we were asked to call up at 5 pm. Luckily we got. She was admitted around 7.30 pm.

She was put on IV fluids, and given Dolo 650 (Paracetamol) and Folvite (folic acid) tablets. Her appetite had reduced to near nil.

Sunday, June 9
She had nausea and wasn't able to eat solid food. So the dietician ordered semi-solid food like kanji (porridge) of rice, rava, raagi etc, and soup. She was also having pomegranate and papaya.

On Sunday at 5 am, her platelet count come down to 90,000. By evening the fever and blood pressure, which was low, had satablilized.

Seeing the way her platelet count was dropping, I networked among my friends to look for papaya leaves. I thought, if papaya leaf juice has to be taken, then why not early enough, rather than when her condition had serious.

Monday, June 10
On Monday at 5 am, the count dropped to 35,000. In retrospect, arranging for papaya leaves the previous day, was a good move. Since her count had dropped below 50,000, her blood sample was taken at 5 pm. Her count hadn't dropped in 12 hours. It was the same 35,000.

By evening, I got the papaya leaves. Since we couldn't mash it and
get the juice then, around 5.30 pm, she took three leaves and chewed
them to get the juice out, and spat out the leaves, like bubble gum.

Since
she had the leaves after the blood sample was taken, the leaves didn't
have any role in arresting the fall of platelet counts. May be
pomegranate and papaya and the water she had did.

Tuesday, June 11
The next day, Tuesday morning at 5 am, the count had gone up to 38,000. She had a teaspoon of papaya leaf juice around 11 am. Blood sample was taken at 5 pm. The count had gone up to 54,000. She was also regularly having lots of pomegranate and also papaya, and lots of water.

Wednesday, June 12
On Wednesday, at 5 am, her count went up to 65,000. I thought she would be discharged on Wednesday. But doctor said it was better her count goes up to at least 80,000. No sample was taken in the evening.

Thursday, June 13
Thursday, at 5 am, the sample was again taken at 5 am. Her count had gone up to 1,28,000. May be the juice had some effect in boosting the platelet count by 90,000 in 48 hours. She was discharged yesterday around 2 pm.

She is very weak. Recovery will take a lot of time. She will have to take a lot of fluids, and may be another round of papaya leaf juice.

MY SUGGESTIONS:

If you get fever, especially when there are lot of dengue cases in your city, don't ignore fever. If it doesn't subside within two days, go to a doctor.

Don't panic. Even if the doctor suspects it's dengue, and later it is confirmed it's so, don't panic. Do get admitted to a hospital, where your platelet count can be regularly monitored.

Drink lots of fluids -- water and fruit juice.

Have lots of pomegranate and papaya. If you can get papaya and neem leaves, do arrange for them. Wash the leaves very well. Mash them in mixie with a little water, filter it, and have the juice. Even if there may not not be any good, there won't be any harm.

Recovery will take its time. Eat whatever you feel like. Drink lots and lots of fluid.

I read the post after seeing the post by Rajkumar. There is a serious methodological flaw and the conclusion is flawed.

a) The randomization method is not valid. They did not have a randomization sequence to begin with. They might have perhaps thought they were using permuted block design but this is not the way to go about it (in fact they have done exactly what students are taught not to do as a negative example). The envelopes must be prepared based on an a priori generated sequence by a third party and the envelopes must be numbered serially to avoid bias in allotment of envelopes. Randomization is sequence is the most sacrosanct thing in an open label study that minimizes bias in allotment.

Then if you look at Table 2 you will see that there is no consistent trend with topsy turvy results. The overall treatment effect is not significant (table 3)

Really informative and useful report. I was searching on the web about Dengue when yesterday evening we my daughter tested positive for Dengue. We will get the detailed report in the afternoon and will admit her to the hospital.

my platelets has been dropping since 6 days to 62k.When i approached Safderjung hospital new dethi doctors here told me wait til 20k the time time when bleeding starts. We cant admit til that statge.Can any one explain me, are doctors of safdurjung authorized to deny admission on this ground

Only a doctor will be able to tell if and when a patient needs to get admitted.But I know a two of my friends who got dengue, but didn't get admitted to a hospital. They merely got their blood tested from at a nearby lab, and drank lots of lots of fluids. Wishing you a speedy recovery.

Thank you so much Pradeep ji...... this is very useful for me now.... because my sister is admitted in hospital due to dengue fever so it is very helpful for me to take care of her by your instructions...... Thanks Again

your statement that "There is no well-validated and documented scientific backing for this" Papaya leaf extract is not truly right. you may refer to many of the medical journals which has published this findings, http://www.dhakatribune.com/wellness/2013/aug/30/papaya-leaf-juice-cure-dengue-fever

Ever since this post was written, there has been lot of development regarding relationship between papaya leaf extract and platelet levels. Of late, I have been seeing many doctors prescribing Caripill tablets (which is nothing but papaya leaf extracts) for patients who have low platelet counts.

dear Pradeep,very enlightening! i am treating my four year old at home itself for dengue. papaya leaves juice, pomegranates, kiwis and dragon fruit are all miracles that boost the platelet count. and keeping the patient hydrated is of utmost importance as water mobilizes and throws toxins out of the body, also providing fuel to the platelets. am monitoring her platelets every 48 hours. am also giving her enerzal (just like electral) which she keeps sipping through out the day. also coaxing and cajoling while feeding her palak, carrots, broccoli, eggs and crab meat rich food is making a difference too!the rest is precautions...and prayers.thank you.god bless.thank u so much.

The mosquitoes just want to have fun as well. Drinking beer is going to make you more attractive to Australian mosquitoes but certainly the more you drink the less likely you will remember to put on repellent. To prevent from mosquito bites, visit mosquito net for windows

Very informative post review. I am pleased to have come accross this article. I was eagerly looking for a post that give such information. Keep it up.I have some relevant information you can review below.Apotheke Langenhagen

Thanks Prasanth for the valuable post. My wife is also having high temperature and fever which won't subside with paracetamol. We had a CBC blood test this eve and just got the result stating that her platelets count is 151 thousands. Just above normal. She doesn't have any other symptoms for dengue.

Thanks Prasanth for the valuable post. My wife is also having high temperature and fever which won't subside with paracetamol. We had a CBC blood test this eve and just got the result stating that her platelets count is 151 thousands. Just above normal. She doesn't have any other symptoms for dengue.

Beware of Papaya Leaf Extract, though. It does not work uniformly for everyone. I gave it to my mom and the platelet count dropped by almost 100000. It doesn't work for everyone so please keep this in mind.

May and June are not Summers in India , they are more of mosquito season , Specially dengue , a life threatening and life taking disease. Indians still go for home remedies to increase platelet counts rather than going to a doctor, they rely on papaya leaves juice and its really effective as well. It increases the platelets count.

Dengue infection is a leading cause of death and sickness in tropical and subtropical parts of the world. Dengue is caused by one of four viruses that are transmitted by the bite of an infected mosquito. Dengue hemorrhagic fever is a more serious form of dengue infection.

Thanks for the blog, I found it very useful. My wife was recently tested positive for Dengue and we started the concoction of Papaya leaf and Giloy (from Patanjali). It definitely has helped tremendously. If started in very initial stage, the platelet count does not fall below 1 lacs.

I am NOT a doctor. However, I have seen Caripill tablets being prescribed by doctors for people who have low platelet counts.But since I am not a doctor, please consult a physician and follow the advice she gives.

Hi, i am from India, Tamil nadu.i had dengue fever on 5th april. My platelet counts went to 9000.i started taking papaya leave juice from 10th april. Its shows good result and rapidly increased platelate counts. 5 days ago i took blood test 186000 platelet counts increase. I am feel good now. From 10th onwards to Still today i taking 2 tea spoons papaye leaf juice everday. How long i continue having papaya leaf juice or certain stage i have to stop it or not?

a week is good enough. once the platelets start increasing you can support the count with a proper diet. eat plenty of carrots, green peas, broccoli, spinach, kiwi, dragonfruit and crab meat, chicken and eggs if you are a non-vegetarian. avoid spicy and fried food. but you can generously eat healthy and wholesome homemade food. above all keep yourself hydrated at all times, especially during summer. the more hydrated you are, the more toxins will be thrown out from your body.happy recovery :D

now, just a mother who's been there and done that, when 3 years back my then 4 year old angel came down with dengue. in fact, that's when i chanced upon your wonderful blog and had posted my comment too :D

Thanks for the wonderful article. Mosquitoes are very dangerous and harmful so the best option is to avoid them. And the best natural way is the window mosquito nets and bed mosquito nets. Repellents can also cause health problem.

Hi, My uncle age 50+ is now suffering from dengue. his platelet count has gone down. I need to know how much quantity of papaya we should give him daily....to increase the platelet count.... Please help me ... it is urgent brother. Thank you in advance...

hi faraz,first of all keep the patient hydrated at all times, by default. you need to give papaya leaves juice, not papaya the fruit.the leaves have to be slightly bigger than your palm. that way they are not too young or too mature. they have more benefits. the leaves have to be free from chemicals and mainly bugs. check the underside of the leaf for mealy bugs (white, wool like tiny bugs). do not ingest infected leaves even by washing them.3 papaya leaves.wash them well and pat dry.crush them by hand in a stone mortar and pestle (patthar ka khal-batta). if you don't have one then grind them with a tablespoon of filtered water in the smallest (chutney) attachment of your mixer grinder. strain them through a fine sieve as you need to extract as much juice as possible. this will yield up to an ounce (30 ml) of the juice. it is so bitter that bitter gourd (karela) seems sweet in comparison! (now, don't scare the patient by saying that!) get the patient to swallow it in one gulp. do not let the juice linger on the tongue as it may make the patient want to (or actually) throw up. have a couple of sips of water after consuming the fresh juice, just a couple, not more, as we don't want the benefits to get diluted.if the patient can't have it plain then you can add some honey or jaggery to it, not much. also, stevia can be added to cut down the bitterness. it won't do a big job though as the bitterness is truly overwhelming.

always consume fresh juice only. do not make it in advance and store it for later use. it deteriorates fast.have it 3 times a day for a week.

keep a tab on the platelet count. get them tested every 48 hours for a week. do not worry if the haemoglobin count drops. you have to let the platelets increase first.

drink lots and lots of water and freshly squeezed juices. kiwi and dragon fruit are wonder fruits. loaded with vitamin c too, they help in increasing the platelet count tremendously. eat at least 2-3 kiwis a day for a week. you could also make banana and kiwi juice, slightly watery, with a pinch of rock salt and a tad of sugar or honey. do not strain the juice. this tangy juice can be had twice a day. bananas also have vitamin b and potassium. they help restore vitamin b which is essential for healing along with potassium.lime juice (nimbu paani), strained pomegranate and apple juices of watery consistency work wonders too. if diabetic, then do consider the sugar (added) intake.

you can also give electral or enerzal (now you get them in 200 ml tetrapacks and flavoured too). 2 packs a day for a week.

stay protected at all times. use mosquito nets and repellents. even lotions and patches on oneself. avoid wearing dark coloured clothes as mosquitoes are attracted to dark colors. keep your home and environment clean and stagnant water free.